Five-year incidence of Nd:YAG laser capsulotomy and association with in vitro proliferation of lens epithelial cells from individual specimens: a case control study

Abstract

BackgroundThe aims of this study were to determine the 5-year incidence of posterior capsule opacification (PCO) requiring Nd:YAG laser capsulotomy in a representative mixed cohort of cataract patients, to determine risk factors for PCO and to investigate possible association with growth of human lens epithelial cells (HLEC) in vitro.MethodsPieces of the anterior lens capsule and adhering HLEC were obtained at cataract surgery and cultured individually. After one and two weeks respectively, cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent cell layer. The 5-year incidence of Nd:YAG laser capsulotomy in this cohort was determined through medical records and by mail or telephone interviews. For statistic analyses Mann–Whitney U-test, Fisher’s exact test and binary logistic regression were used.ResultsData on treatment/no treatment for PCO was obtained from 270 patients with a median follow-up time of 57 months (range 50–64 months). The three-year cumulative incidence of PCO was 5.2% and the cumulative 5-year incidence was 11.9%. Patients who had undergone Nd:YAG laser capsulotomy were significantly younger (median 71 years) than patients who did not receive treatment for PCO (median 75 years, p = 0.022). Logistic regression demonstrated that apart from younger age, follow-up time and type of intraocular lens (IOL) were associated with risk of PCO, with hydrophilic 1-piece IOLs conferring a higher risk than hydrophobic acrylic 1-piece or 3-piece IOLs (adjusted OR = 9.4, 95% CI 2.5-35.7, p = 0.001). Of the 270 patients from whom information could be retrieved regarding PCO treatment, in vitro cell culture could be established and quantified from 185 patients. No significant difference in cell growth in vitro was shown between patients subsequently requiring/not requiring Nd:YAG laser capsulotomy.ConclusionsThe cumulative 5-year incidence of 11.9% is comparable or slightly higher than reported in other recent studies. The type of IOL was the most important risk factor for PCO in this study, whereas intrinsic proliferative capacity of the individual’s lens epithelial cells seems to be less important for subsequent PCO development.

Lens Epithelial Cells Initiate an Inflammatory Response Following Cataract Surgery

“… 1 , 4 Despite these advances, postsurgical inflammation and ocular fibrosis derived from EMT of residual LECs are still significant barriers preventing ideal visual outcomes. 9 , 100 – 102 Overall, this study provides new insights into the pathophysiology of cataract surgery side effects and implies that the LECs remaining behind following cataract surgery are signaling centers promoting PCS inflammation.…”

Phacoemulsification and primary implantation with bag‐in‐the‐lens intraocular lens in children with unilateral and bilateral cataract

“…; Sundelin et al. ). However, with the design of the BIL‐IOL, PCO is not an issue and the hydrophilic material can be used.…”

“…The BIL-IOL implanted in the present cohort is made of hydrophilic acrylic material. Several studies have demonstrated a higher incidence of PCO in hydrophilic as compared to hydrophobic IOLs (Li et al 2013;Sundelin et al 2014). However, with the design of the BIL-IOL, PCO is not an issue and the hydrophilic material can be used.…”

Long-term effectiveness and safety of a three-piece acrylic hydrophobic intraocular lens modified with hydroxyethyl-methacrylate: an open-label, 3-year follow-up study

“… 16 Across studies, the reported incidence of Nd:YAG laser capsulotomy is between 2% and 67%, and the reported rates vary depending on the follow-up period and the type of IOL. 17 – 22 The risk of Nd:YAG laser capsulotomy is reported to be sevenfold higher with hydrophilic lenses than with the hydrophobic lenses. 11 …”